MPV/PLT比值对老年慢性阻塞性肺疾病合并呼吸衰竭患者严重程度及预后的评估价值

The value of MPV/PLT ratio in assessing the severity and prognosis of patients with chronic obstructive pulmonary disease complicated with respiratory failure

目的探讨MPV/PLT比值对老年慢性阻塞性肺疾病合并呼吸衰竭患者严重程度及预后的评估价值。方法选取2021年10月—2022年10月上海市浦东新区浦南医院和杨思医院呼吸科住院的老年慢性阻塞性肺疾病患者180例,根据有无呼吸衰竭分为呼吸衰竭组(90例)和非呼吸衰竭组(90例)。收集患者PLT、MPV、N、WBC、PCT、乳酸、D-二聚体、IL-6、IL-8等指标值及APACHEII评分值,计算出MPV/PLT比值,比较2组各指标值差异;记录呼吸衰竭组患者入院后28 d内的生存情况,并分为生存亚组和死亡亚组,比较2亚组IL-6、IL-8水平、APACHEII评分值及MPV/PLT比值的差异;探讨MPV/PLT比值与血PCT、CRP、IL-6、IL-8水平、APACHEII评分值的相关性;绘制ROC曲线,评估MPV/PLT比值对慢性阻塞性肺疾病合并呼吸衰竭患者预后的价值。结果老年慢性阻塞性肺疾病中呼吸衰竭组和非呼吸衰竭组中WBC值比较,差异无统计学意义(P>0.05);与非呼吸衰竭组比较,呼吸衰竭组年龄、乳酸、MPV、N、CRP、IL-6、IL-8、PCT、D-二聚体、APACHEII评分、MPV/PLT比值偏高,PLT水平偏低,差异均有统计学意义(P<0.001);WBC在生存亚组和死亡亚组中比较,差异无统计学意义(P>0.05);与生存亚组比较,死亡亚组的乳酸、MPV、N、PCT、IL-8、D-二聚体、APACHEII评分、MPV/PLT比值偏高,PLT水平偏低,差异均有统计学意义(P<0.05);呼吸衰竭患者中MPV/PLT比值与IL-8水平、APACHEII评分值呈正相关,相关系数(rs)分别为0.394、0.306,差异均有统计学意义(P=0.001、P=0.004)。MPV/PLT比值预测呼吸衰竭患者死亡的ROC曲线下面积为0.942(95%CI:0.895~0.989),最佳截断值为0.0405,敏感度100%,特异度81.2%。结论MPV/PLT比值在预测老年慢性阻塞性肺疾病合并呼吸衰竭病情变化有一定的临床应用价值,有助于指导临床医师对病情严重程度的评估及预后的判断。

Objective To investigate the value of MPV/PLT ratio in assessing the severity and prognosis of patients with chronic obstructive pulmonary disease(COPD)complicated with respiratory failure.Methods 180 elderly patients with COPD who were hospitalized in Department of Respiratory,Punan Hospital and Department of Respiratory,Yangsi Hospital,in Pudong New District from October 2021 to October 2022 were selected.They were divided into respiratory failure group(90 cases)and non⁃respiratory failure group(90 cases)according to the presence or absence of respiratory failure.The data of PLT,MPV,N,WBC,PCT,lactic acid,D⁃dimer,IL⁃6,IL⁃8 and APACHEII scores of patients were collected,the MPV/PLT ratio was calculated,and the differences of above indexes value were compared between the two groups.The survival con⁃dition of patients in the respiratory failure group within 28 days after admission was recorded,and they were divided into surviv⁃al subgroup and death subgroup.The differences in the levels of IL⁃6 and IL⁃8,APACHEII score,and MPV/PLT ratio were compared between the two subgroups.The correlation between MPV/PLT ratio and the levels of blood PCT,CRP,IL⁃6 and IL⁃8 and APACHEII score was explored.ROC curve was plotted to evaluate the prognostic value of MPV/PLT ratio in patients with COPD complicated with respiratory failure.There was no significant difference in WBC between the respiratory failure group and the non⁃respiratory failure group(P>0.05).Compared with the non⁃respiratory failure group,the respiratory fail⁃ure group had older age,higher levels of lactic acid,MPV,N,CRP,IL⁃6,IL⁃8,PCT and D⁃dimer,higher APACHEII score,higher MPV/PLT ratio and lower PLT level,and the differences were statistically significant(P<0.001).There was no significant difference in WBC between the survival subgroup and the death subgroup(P>0.05).Compared with the surviv⁃al subgroup,the death subgroup had higher levels of lactic acid,MPV,N,PCT IL⁃8,and D⁃dimer,higher APACHEII score,higher MPV/PLT ratio and lower PLT level,and the differences were statistically significant(P<0.05).MPV/PLT ratio was positively correlated with IL⁃8 level and APACHEII score in patients with respiratory failure,and the correlation coefficients(rs)were 0.394 and 0.306,respectively,with statistical significance(P=0.001,P=0.004).The area under the ROC curve for the MPV/PLT ratio to predict death in the patients with respiratory failure was 0.942(95%CI:0.895⁃0.989),with an op⁃timal cut⁃off value of 0.0405,sensitivity of 100%and specificity of 81.2%.Conclusion The MPV/PLT ratio has certain clinical application value in predicting the changes in the condition of elderly patients with COPD complicated with respiratory failure,which is helpful to guide clinical physicians to evaluate the severity of the condition and predict prognosis.